Epilepsy Talk

Neurologist or Epileptologist — Who is Best for YOU? | June 2, 2013

Do you have a neurologist? Or is your epilepsy followed by your primary care physician? Should you see an epileptologist?

There is no strict definition of what an epileptologist is. (Although the term was first made popular by William Spratling, now regarded as North America’s first epileptologist.)

Generally speaking, an epileptologist is a neurologist who has a specific interest in, and focuses on, epilepsy.

To become a neurologist in the U.S., one must graduate from medical (or osteopathic medicine) school, and then complete a neurology residency (training) for four years.

After that, the neurologist can sub-specialize in a more specific field of neurology, including epilepsy. (Other examples include nervous system disorders — including diseases of the brain, spinal cord, nerves, and muscles, stroke, pain, neuromuscular disease, and movement disorders).

This additional subspecialized training is referred to as a fellowship, and usually consists of one or two years of additional training.

In addition to the duration, there is great variability in the type of fellowship: the proportion of patient care versus “clinical neurophysiology” (EEG), the type of center (surgical versus not) and the volume of the clinic and epilepsy monitoring unit.

What kind of training do neurologists and epileptologists have?

Neurologists are medical doctors who have completed:

Four years of medical school

At least one to two years of pediatric residency

Three or more years of residency training in adult and child neurology

An epileptologist has: Additional fellowship training beyond residency in EEG interpretation and epilepsy.

Who needs an epileptologist?

Most patients with epilepsy do not need an epileptologist and should be followed by a general neurologist. The ones that do are the (roughly) 30% whose seizures are not controlled, difficult to diagnose or do not respond to standard therapy, as with the first two or three anti-epilepsy medications.

For those with drug resistant epilepsy, it is important that they be given specialized care, which typically begins with EEG-video monitoring, and can result in the rectification of a wrong diagnosis, change in medications, or surgical procedures.

Other reasons that may justify an expert (epileptologist) opinion include medication side effects, pregnancy, and complicated issues related to disability or driving.

“I have 1,200 patients and they all have epilepsy,” says Dr. Elizabeth A. Thiele, M.D., Ph.D., Director of the Pediatric Epilepsy Program, Massachusetts General Hospital. But that doesn’t mean you need an epileptologist, she adds. “Most neurologists are extremely competent at treating epilepsy because they’ve seen so many cases and because epilepsy is so common.”

In most cases, a neurologist can help you find the proper medication and treatment to control seizures. When cases are particularly complex or resistant to medication, or if surgery may be indicated, a neurologist often will refer the patient to an epileptologist for evaluation.

Although epileptologists are in relatively short supply, the best place to find one is in an academic teaching hospital, specialized epilepsy center or in a private practice.

Other articles that may be of interest include:

2013 Comprehensive List of GOOD Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors https://epilepsytalk.com/2013/01/02/2013-comprehensive-list-of-good-neurologistsepileptologistsneurosurgeonsand-pediatric-doctors/

2013 Top Ranked Neurology and Neurosurgery Hospitals — For Adults and Children https://epilepsytalk.com/2013/01/03/2013-top-ranked-neurology-and-neurosurgery-hospitals-for-adults-and-children/

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Resources:

http://my.epilepsy.com/newsletter/jan13/epileptologist?utm_source=Epilepsy+Therapy+Project&utm_campaign=b48397ae45-Epilepsy_News_1_16_13&utm_medium=email

http://www.epilepsyadvocate.com/living-with-epilepsy/adult.aspx

http://www.ice-epilepsy.org/when-to-see-neurologist.html

http://www.epilepsyconnection.org/Diagnosis.html

http://www.aesnet.org/find-a-dr/find-a-doctor-epilepsy-com

 


24 Comments »

  1. I have the double pleasure of having MS and Epilepsy, my neurologist specialises in Epilepsy but with the help of my MS nurse deals with that quite well too. I guess I am lucky?

    Like

    Comment by mickcgorman — June 5, 2013 @ 6:51 AM

  2. It has taken a while, but after several months of trying we have finally gotten on the list to see an epileptologist. Unfortunately the waiting list is a mile long and my foster son cannot get in to see him until sometime next year.

    We were hoping for a summer appointment so that the 1-week visit would not affect his attendance at school. With the waiting period being so long, the doctor’s office could only tell me it will likely be a summer appointment, just not this summer – most likely next summer.

    I guess this is better than no appointment at all, but all the same, it is not cool that it needs to take this long to try stop all the random seizures.

    Like

    Comment by Scott Oosterom — June 24, 2013 @ 4:14 PM

  3. I had a epileptologist and a neurologist but my epileptologist moved away and my neurologist told me he doesn’t need to see me even one a year. He lets my physican take care of it all which I fell is unfair. It’s just our gorvenment trying to save money. Its pretty poor I think.

    Like

    Comment by Shawna — August 3, 2013 @ 3:52 PM

  4. Shawna,

    Do you think you might find someone appropriate from the list above?

    It’s a compilation by website forum members who have had positive personal experiences with docs over the years.

    2013 Comprehensive List of GOOD Neurologists…Epileptologists…Neurosurgeons…and Pediatric Doctors

    https://epilepsytalk.com/2013/01/02/2013-comprehensive-list-of-good-neurologistsepileptologistsneurosurgeonsand-pediatric-doctors/

    Like

    Comment by Phylis Feiner Johnson — August 3, 2013 @ 4:50 PM

  5. Shawna,

    How about a teaching hospital near you? (Depending upon where you live.)

    Here’s the other suggestion…

    2013 Top Ranked Neurology and Neurosurgery Hospitals — For Adults and Children

    https://epilepsytalk.com/2013/01/03/2013-top-ranked-neurology-and-neurosurgery-hospitals-for-adults-and-children/

    Like

    Comment by Phylis Feiner Johnson — August 3, 2013 @ 11:10 PM

  6. Can a microwave effect an 18 year old dbs

    Like

    Comment by Curtis McMurtrey — October 15, 2016 @ 9:04 PM

  7. What is a “dbs”?

    Like

    Comment by Phylis Feiner Johnson — October 15, 2016 @ 10:26 PM

  8. Deep brain stimulator

    Like

    Comment by Curtis McMurtrey — October 16, 2016 @ 7:27 PM

  9. I looked it up and basically, it said not to expose a DBS to any heat induced treatment. How that would relate to a microwave, I’m not sure.

    https://professional.medtronic.com/pt/neuro/dbs-md/ind/product-advisories/WCM_PROD083579#.WATDlOArLtU

    https://en.wikipedia.org/wiki/Diathermy#Microwave

    Like

    Comment by Phylis Feiner Johnson — October 17, 2016 @ 8:37 AM

  10. You stated that to become a neurologist in the U.S., one must graduate from medical (or osteopathic medicine) school, and then complete a neurology residency (training) for four years. My daughter has been sent home early from school every day this week because of some severe headaches she has been having. Do most people have to be referred by a general physician to see a neurologist? Going to see a neurologist could be a good option.

    Like

    Comment by mcdooglederek — October 27, 2016 @ 8:04 PM

  11. It’s best to be referred to a neurologist by your internist.

    Another thing (not to scare you) is that migraines can be closely allied with seizures.

    You might find this article interesting:

    Epilepsy & Migraines — Kissing Cousins

    https://epilepsytalk.com/2010/09/12/epilepsy-migraines-kissing-cousins/

    Whether she has seizures or not, just the migraines in and of themselves are a reason to see a neurologist.

    Like

    Comment by Phylis Feiner Johnson — October 28, 2016 @ 9:14 AM

  12. I have a neurologists has denied me of one of my medications, and I didn’t think that was right of him to that. So I am wondering if u should look for a new neurologist.

    Like

    Comment by Jackie — February 24, 2017 @ 11:48 PM

  13. Jackie, did he give you a reason why?

    If not, I would seek another opinion or evaluation.

    Here’s a link to help…

    It’s a compilation by website forum members who have had positive personal experiences with docs over the years.

    2017 Patient Recommendations for TOP Neurologists…Epileptologists… Neurosurgeons…and Pediatric Doctors

    https://epilepsytalk.com/2017/01/14/2017-patient-recommendations-for-top-neurologistsepileptologists-neurosurgeonsand-pediatric-doctors/

    Good luck.

    Like

    Comment by Phylis Feiner Johnson — February 25, 2017 @ 11:07 AM

    • That’s what I’m looking into, I have found like 28 of them. And a few of them are on my list that I have found. Thank you. And yes I did ask, and didn’t get an answer. So I think it’s time for a new one.

      Again thank you.

      Like

      Comment by Jackie — February 25, 2017 @ 11:15 AM

  14. Yes I did ask, and I got no reply as to why he denied me my medication. And I am looking into getting a new neurologist or epilepologist. I found like 28 of them around where I am from. Hopefully I can find the right one.

    Like

    Comment by Jackie — February 25, 2017 @ 11:28 AM

    • Kind of strange that he denied your medication without a reason or explanation. That’s just not professional or right, in my opinion.

      Like

      Comment by Phylis Feiner Johnson — February 25, 2017 @ 2:28 PM

  15. That’s my thought too. That is why I think t was or is time to change neurologists.

    Like

    Comment by Jackie — February 25, 2017 @ 3:14 PM

  16. I just told my husband what was going on, and he thinks a stupid idea for me to change neurologists. He says I should have called and talked to them instead of messaging them. And not getting an answer back.

    Like

    Comment by Jackie — February 25, 2017 @ 5:23 PM

    • Well, you can always invite him to come to your next neuro appointment and figure out the meds.

      But if you didn’t get a reply, that’s not the same as getting refused.

      Like

      Comment by Phylis Feiner Johnson — February 25, 2017 @ 6:12 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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